NATIONAL 2 (Spotlight Weekly)]

Ticking Time Bomb

Nepal risks slipping down the slope if the epidemic is not dealt with quickly and properly

By KESHAB POUDEL

Until half a decade ago, few people knew much about HIV and AIDS. They were regarded as the afflictions of sex workers and the people who patronized them. That perception has changed with the years. HIV\AIDS has become common in the community.

Ministry of Health : Policies need modification

AIDS is not new to Nepal. For many years, the disease was confined mostly to drug users and sex workers, which made it easier for the rest of the country to pretend it did not exist. Because of lack of efficient programs, AIDS crept into the general population.

According to the National Center for AIDS and STD Control, 1,376 people were identified as HIV-positive by the end of May this year. Of them, 400 have been found suffering from full-blown AIDS (Acquired Immune Deficiency Syndrome). Since the HIV virus was first detected in four people in 1989, 500 people have died of AIDS, say officials.

Since the beginning of the epidemic, HIV\AIDS has killed 21.8 million people around the world, 4.3 million of them children, and has created an orphan population of more than 13.2 million.

But that could only be the tip of the iceberg. According to independent and non-governmental studies, there are more than 50,000 HIV patients in Nepal. The disease related to HIV/AIDS is growing fast but the speed of the government is inadequate to contain it. Sharing an open border with India on three sides, Nepal cannot have easy time as far as HIV\AIDS is concerned. International health organizations have already warned that India will have the highest number of AIDS cases in the world.

Thanks to the spread of drug abuse, AIDS has turned into a chronic disease in the developed world. In the 20 years since the first reports of what we now know was AIDS emerged, an entire generation has been born and come of age never knowing a world without the epidemic.

From rural areas to cities, one can see a large number of people infected with the deadly disease. A cure is yet to be found, and very few people in the rich countries can afford the cocktail of medication that can slow the growth of disease.

Dozens of new individuals are afflicted with HIV in Nepal each month. Globally, 5.3 million people worldwide — 14,500 a day — were infected in 2000. The figure was lower than that of 1999 when 5.4 million were infected.

According to UNAIDS, the United Nations agency entrusted with dealing with the epidemic, in 1999, the disease claimed the lives of 2.8 million people, half of whom were children. In 2000, the death toll from the disease reached three million.

If infections are allowed to climb beyond the existing ratio, scientists believe the chances of keeping the disease from accelerating would be slim. Nepal is at the crossroads. It is still in the early stages and HIV\AIDS is easy to control.

Bir Hospital : Is it well equipped

"The government is very serious to control the spread of HIV\AIDS. With support from the World Health Organization and UNAIDS and other international agencies, the government has been launching a nation-wide awareness programs," said Minister of Health Ram Krishna Tamrakar.

Thousands of Nepalese go to Indian cities in search of jobs each year. Away from home for several years, most of them visit Indian brothels in cities like Mumbai, Calcutta and New Delhi regularly.

It is estimated that nearly 200,000 Nepalese girls and women are serving as sex workers in brothels in different Indian cities. Nearly 5,000 girls are trafficked from Nepal to India every year. And the trade continues unabated.

Every year hundreds of Nepalese girls infected with HIV return from Indian brothels. As there are only a few organizations to rehabilitate these girls, one cannot rule out the possibility of the disease spreading.

Although Maiti Nepal, a well-known non-governmental organization working to rehabilitate the girls, runs more than half a dozen of transit point in the border areas to rescue the girls and rehabilitate them, attention at the wider official and non-government level is lacking.

Upon their return, Nepalese workers as well as Nepalese trafficked girls carry the dreaded virus back home with them. Even far-flung areas of the country are suffering from the problem. In the rural areas like Accham, more and more women infected with STD visit the clinic.

Initially, the disease was confined to some groups like IV drug users, patient with sexually transmitted disease. Now it spreads from brothel to brothel, through the blood supply and shared needles. It spread from the cities to the country. Eventually, it spread to innocent girls.

Although the Nepalese government has already approved a National Strategic Plan for AIDS and STD Prevention with technical assistance from the United Nations Development Program and UNAIDS, it is yet to successfully implement awareness and other programs.

Based on the national AIDS policy, the strategic plan emphasizes on multi-sectoral activities and close collaboration between NGOs, private sector and other governmental sectors in the effort to prevent HIV\AIDS. The plan also calls for crating an enabling environment for prevention efforts and care for those infected and affected by HIV\AIDS.

Public health experts hold the view that HIV\AIDS have dramatic effect on productivity, trade and investment. Nepal may have many other epidemics, but it cannot ignore the challenges posed by AIDS.

The disease is now more prevalent among the youth population, particularly among those who take drugs through intravenous injections. "In some cities up to 50 percent of the drug users have been carrying the HIV virus," said Dr. V.L. Gurubacharya, a senior STD and AIDS specialist. "The disease has been found among commercial sex workers and their clients in different parts of the country. Men working away from homes have been found transmitting the disease they have contracted from sex workers to their wives. In this way the disease is also spreading among the general population of the country."

According to studies, high-risk behavior groups like sex workers, transport workers, migrant workers, police and army personnel who live away from their homes most of the time are more prone to HIV infection.

As the government is yet to launch effective nation-wide programs to raise awareness among the large section of the population, the spread of HIV continues. The government must step up action before it is too late.